Insulin secretion and insulin resistance in patients with chronic hepatitis C

The prevalence of type 2 diabetes mellitus is significantly higher in patients with chronic hepatitis C than in those with chronic hepatitis B or even healthy subjects. Although insulin resistance appears to play an important part in the pathogensis of diabetes in these patients, the exact mechanism of this finding is not completely known. High levels of pro-inflammatory cytokines was suggested as a possible mechanism. This work was conducted to detect the primary mechanism of development of diabetes in individuals with HCV infection. A total of 30 non-diabetic non-cirrhotic patients with chronic hepatitis C were included in the study and 15 non-diabetic non-cirrhotic patients with chronic hepatitis B served as the control group. Both groups were closely matched by age, gender, BMI and transaminases. Insulin resistance, beta-cell function, and proinflammatory cytokines [TNF-alpha and 1L6] were evaluated in both .groups. There was no difference between the patients with chronic hepatitis C and those with chronic hepatitis B as regards Beta cell function as determined by HOMA-beta [3 16 +/- 184 vs 248 +/- 225, P>05] but insulin resistance as determined by HOMA-IR [6.5 +/- 4.4 vs 2.8 +/- 1.6, P<.05] and serum levels of TNF-alpha [7.3 +/- 2.8 vs 5.l +/- o.9, p<.01] and IL-6 [419.2 +/- 137.6 vs 302.2 +/- 80.6, P<.05] were significantly higher among the patients with chronic hepatitis C than those with chronic hepatitis B. There was no correlation between HOMA-IR and each of age of patients, FPG, ALT, viral load as measured by HCV PCR and levels of TNF-alpha and IL-6 [P>05]. Insulin resistance may be the primary mechanism of development of diabetes in patients with chronic hepatitis C. Although pro-inflammatory cytokines are increased in these patients, other causes and mechanisms may also be implicated in development of the insulin resistance in these patients

Anthropometric criteria of type-2 diabetics attending national institute of diabetes and endocrinology [NIDE]

Egyptian people have a body shape and cardiovascular risk profiles different from that of other ethnic populations. This study aimed at assessment of anthropometric indices of type-2 diabetics attending National Institute of Diabetes and Endocrinology [NIDE] and to examine the association of these anthropometric indices with hypertension, dyslipidemia, and uncontrolled DM among type-2 diabetics. Besides, to determine which indices can best predict these individual risk factors among these patients. A total of 500 type-2 diabetic patients [79.2% females and 20.8% males], of which 79.6% were obese and 20.4% non obese were enrolled in this work. Their mean age was 51.2 +/- 6.36 year and their mean duration of DM was 11.5 +/- 6.26 year. The anthropometric indices [BMI, WC, WHR and WHTR] of our type-2 diabetics were measured. The history taking, a thorough physical examination and blood sampling for fasting plasma glucose, lipid profile, glycated hemoglobin and creatinine were done for every patient. The prevalence of obesity, central obesity, hypertension, dyslipidemia and uncontrolled DM among our patients were of 79.6%, 89.6, 49.9%, 93.0% and 87.0%, respectively. Most of anthropometric indices [all except WHR] were associated with blood pressure [systolic and diastolic] but all of them were associated with some types of blood lipids. Binary logistic regression revealed that WC was the only anthropometric predictor of hypertension and dyslipidemia among our type-2 diabetics. Both obesity and central obesity are very common among our type-2 diabetics particularly in females. Although most of anthropometric indices are associated with high blood pressure and blood lipids levels, waist circumference is the only anthropometric predictor of hypertension and dyslipidemia among our type-2 diabetics

Vascular endothelial growth factor and diabetic nephropathy in type-2 diabetic patients

Diabetes usually accompanied with multiple complications affecting both the microvasculature and macrovasculature. Vascular endothelial growth factor [VEGF] has been implicated in the pathogenesis of diabetic nephropathy. This study was designed to investigate serum and urinary VEGF in type-2 diabetic patients and assess whether serum and urinary VEGF levels are related to the severity of diabetic nephropathy. The study included 80 type-2 Egyptian diabetic patients [46 female, 34 male] attending the outpatient clinics of NIDE and 30 normal controls. Blood pressure, BMI, FBS, HBA1c, lipid profile, urea, creatinine, uric acid, microalbuminurea and VEGF [serum and urine] were measured. Fundus examination, chest X-ray and ECG were performed for all subjects and echocardiography was done when indicated. There was a significant increase in plasma VEGF concentrations in diabetic patients than in normal controls. Patients with higher levels of serum VEGF concentrations had a significant increase in systolic BP, diastolic BP, FBS, HbA1c, serum creatinine, albumin/creatinine ratio and retinopathy than those with lower levels of serum VEGF concentrations. There was also a significant increase in urinary VEGF concentrations in diabetic patients than in normal controls. Urinary VEGF levels appeared to be positively correlated with both urinary ACR and serum creatinine. These data demonstrate the ability to reveal new markers for diabetic nephropathy, an important step forward in advancing accurate diagnosis and understanding of disease mechanisms

Serum ferritin level in poorly and well-controlled type 2 diabetic patients attending the outpatient clinics of NIDE

Serum ferritin level is related to body iron stores and is influenced by several diseases. This study was undertaken to evaluate the association between serum ferritin concentration and glycemic control. One hundred and twenty type 2 diabetic patients attending the outpatient clinics of the National Institute of Diabetes and Endocrinology [NIDE] and one hundred and twenty normal healthy controls were involved in this study. We confirmed that serum ferritin was increased in diabetic patients as long as glycemic control is not achieved. Thus, serum ferritin can be recommended as a marker of glycemic control. However, these findings and the possible use of serum ferritin as a predictor of diabetic microangiopathic complications, especially diabetic retinopathy, must be confirmed by additional studies comprising more subjects

Impact of obesity on micro-angiopathic complications among article type-2 diabetics

Obesity is characterized by impaired microvascular function that may contribute to develop obesity-related microangiopathy, hypertension as well insulin resistance. Only a few investigations have focused on the role of obesity in the development or progression of microvascular complications among type-2 diabetics. This was conducted to investigate whether obesity has an impact on the risk of diabetic retinopathy, nephropathy and neuropathy in type-2 diabetic persons. Our work is a retrospective study in which we reviewed and analyzed the data of randomized 2715 type-2 diabetics who attended the medical outpatient clinics of NIDE. According to BMI, patients were randomized into 3 groups: normal-weight, over-weight and obese. For all patient funduscopy was performed to detect retinopathy, the diagnosis of nephropathy was made when urinary albumin excretion exceeded 30 pg/mg creatinin and neuropathic complications were assessed by vibratone for determining vibration sensation. High prevalence of obesity was determined among our patients [67%] and is more frequent among females than males [64.3% vs 35.7%]. The prevalence of retinopathy, nephropathy and neuropathy in our patients was 23.3%, 23.4% and 46.9%, respectively. Obese patients had higher prevalence of retinopathy [3 1.2%], nephropathy [28.3%] and neuropathy [48.6%] than normal-weight [23.4%, 3.1% and 41.1%, respectively] and in over-weight patients it was [26.6%, 18.5% and 44.1%, respectively]. Logistic regression analysis showed that age >50 years, male sex, duration of diabetes> 10 years and glycated hemoglobin >7 were independent risk factors for retinopathy, while age >50 years, obesity and glycated hemoglobin >7 were independent risk factors for nephropathy, and age >50 years. Female sex, obesity, duration of diabetes> 10 years, glycated hemoglobin >7 and hypertension were independent risk factors for diabetic neuropathy. Obesity is prevalent in our type-2 diabetics particularly among females. Obesity has some impact on diabetic micro-angiopathic complications, especially it is an independent risk factor for diabetic nephropathy and neuropathy

Anti-CCP2 and anti-keratin antibodies in rheumatoid and osteoarthritis patients

The use of the autoantibodies family directed to Citrulline-containing peptides including antibodies to cyclic citrullinated peptides2 [Anti CCP2] and Anti Keratin Antibodies [AKA] test is growing worldwide in the diagnosis of rheumatoid arthritis [RA]. To determine the frequency of Anti CCP2 and AKA and their relation to activity and severity in patients with RA and Osteoarthritis [OA]. 60 patients were recruited for the study; they were equally divided into two groups according to their diagnosis [RA and OA groups]. The thirty patients with RA were diagnosed according to the Revised Criteria for Classification of Rheumatoid Arthritis by the ACR [Arnett et al, 1988]. The thirty Patients with OA were fulfilling the criteria for classification of OA proposed by Altman [1991]. Patients' charts were reviewed for demographic information, clinical diagnosis, and radiographic information. They all had their peripheral blood sampled for CRP, CBC, ESR, IgM RF titre, Anti CCP2 and AKA. The comparison between both studied groups showed significant difference between disease duration and patient's assessment of pain by Visual analog scale [VAS] [p<0.05], while there was no significant difference between both diseases as regard patient's and physician's global assessment of disease activity [p>0.05]. The comparison between both studied groups showed also highly significant differences regarding age, duration, as well as CRP, ESR, Anti CCP2, AKA and IgM RF [p<0.01]. The relation between Activity of RA and severity of OA showed significant relation between both, as regard to Patient's Assessment Of Physical Function [Pt Ass Ph F] in RA patients and OA severity assessed according to Lequesne and Samson, 1991 [p<0.05]. In RA patients, there were significant correlations between each of IgM RF and Anti CCP2 with joint erosions [p<0.05], while there was no significant correlation as regard AKA with joint erosions [p>0.05]. the correlation between each of the IgM RF, Anti-CCP2 and AKA with the clinical assessment items in RA patients [age, disease duration, TJC, SJC, patient's assessment of pain, patient's global assessment of disease activity and physician's global assessment of disease activity showed no significant correlation except for disease duration with AKA [p<0.05]. None of the laboratory assessment items [ESR, CRP, IgMRF, Anti CCP2, and AKA] showed any significant correlation, except for CRP, with both IgM RF and Anti CCP2 [p<0.05]. Also there was a significant correlation between IgM RF and Anti CCP2 [p<0.05]. We concluded that anti-CCP2 could be a very useful serological assay for the diagnosis of RA, because anti-CCP2 revealed higher diagnostic specificity than RF and AKA and could be performed with an easy technique. It also has an independent role in predicting disease activity and has a prognostic value as a marker of erosive disease in RA

Post-streptococcal reactive arthritis versus acute rheumatic fever

A migrating polyarthritis after throat infection with group A beta-hemolytic streptococci is classically attributed to acute rheumatic fever [ARF]. Sterile non-migratory arthritis may occur as a separate entity, the so called post-streptococcal reactive arthritis [PSRA]. To identify clinical and serological differences of reactive arthritis patients after infection with Lancefield group A beta-hemolytic streptococci, as compared with acute rheumatic fever. The study was conducted of 120 patients who were recruited for the study. They were equally divided into two groups according to the diagnosis of ARF or PSRA. They were consecutively seen in the Rheumatology and Rehabilitation and the Pediatric wards. Clinical and laboratory data were assessed through a questionnaire. The diagnosis of rheumatic fever was made based on the revised modified Jones criteria, while the diagnosis of post-streptococcal reactive arthritis was made based on Deighton criteria; these associated with laboratory data, electrocardiography, chest X-rays and bi-dimensional echocardiography. There was no significant difference between both groups as regard age where p>0.05, while there was a significant difference regarding the date of antecedent upper respiratory tract infection [p<0.05]. Clinical assessment showed that the duration of disease and Enthesitis, joint tenderness and joint swelling counts have a highly significant difference [p<0.01]. As regard to the response to aspirin, indomethacin and steroid there were significant differences between both groups [p<0.05]. Also, as regard the laboratory assessment ESR, CRP, ASOT, the differences between both group were highly significant for ESR, ASOT [p<0.01] and significant for CRP [p<0.05]. No significant difference was found between both groups regarding specific laboratory assessment [Anti deoxyribonuclease-B liter or anti-Hyaluronidase] [p>0.05]. Regarding the cardiological changes P-R interval on ECG was prolonged in 19 patients 31.67% and Echo study showed changes in 12 patients, 20% of cases of ARF patients only. Also there were no chest or CNS changes either in ARF or PSRA patients, so, chest X-ray changes showed no significant differencesp>0.01. Post-streptococcal reactive arthritis and acute rheumatic fever are actually having different presentations and managements

Effect of weight quality on bone mass in postmenopausal females

Hypothesis: body weight is positively associated with bone mass. Few studies, however, have examined the relative importance of the fat and lean components of body weight for skeletal mass and the findings are contradictory

Objective: this study was performed find out the relative influence of fat and lean mass on bone mineral density [BMD] in postmenopausal females

Methodology: one hundred and twenty post-menopausal females were classified in to four groups: Group [1]: 30 women non-obese with BMI less than 30 and has at least 5 years after menopause [YAM]. Group [2]: 30 women non-obese with BMI less than 30 and have at least 10 YAM. Group [3]: 30 women obese with BMI above 30 and has at least 5 YAM. Group [4]: 30 women obese with BMI above 30 and has at least 10 YAM

Results: T score: G3 was significantly higher than that for GI p<0.01, G4 was significantly higher than that for G2 p<0.01. Fat weight: G3 was significantly higher than that for G1 p<0.001, G4 was significantly higher than that G2 p<0.001. Lean weight: G3 was significantly higher than that for GI and p<0.001, G4 was significantly higher than that G2 p<0.001

Conclusion: both lean weight and fat weight have a positive effect on bone density but bone density appears to be affected by lean weight more than fat weight

Serum ferritin levels in poorly- and well-controlled diabetes mellitus

Serum ferritin level is related to body iron stores and is influenced by several diseases. This study was performed to evaluate the association between serum ferritin concentration and the complications and nature of diabetes mellitus [DM]. We examined association of ferritin concentration, fasting and postprandial glucose levels and glycated hemoglobin in 120 patients with type 2 diabetes mellitus and 50 healthy controls. We confirmed that serum ferritin was increased in diabetic patients as long as glycemic control is not achieved. There was also a correlation between ferritin level and diabetic neuropathy. This study showed an independent positive association between serum ferritin concentration and markers of glucose homeostatsis

Serum ferritin levels in poorly- and well-controlled diabetes mellitus

Serum ferritin level is related to body iron stores and is influenced by several diseases. This study was undertaken to evaluate the association between serum ferritin concentration and the complications and nature of diabetes mellitus [DM]. We examined association of ferritin concentration, fasting and postprandial glucose levels and glycated hemoglobin in 120 patients with type 2 diabetes mellitus and 50 healthy controls. We confirmed that serum ferritin was increased in diabetic patients as long as glycemic control is not achieved. There was also a correlation between ferritin level and diabetic neuropathy. This study showed an independent positive association between serum ferritin concentration and markers of glucose homeostatsis

Dysregulation of the fibrinolytic system in normal glucose tolerant offspring of type 2 diabetic patients

Impaired fibrinolysis increases the risk of cardiovascular diseases and favors the intravascular deposition of fibrin. Fibrinolysis is regulated through plasminogen activators, and especially inhibitors, primarily the plasminogen activator inhibitor-l [PAI-l]. First-degree relatives of type 2 diabetic subjects are supposed to be genetically prone to the development of clinical disease. It might be possible that hemostatic dysregulalion may be present even in normal glucose tolerant first-degree relatives. In the present study, we aimed to investigate the hemostatic parameters, including tissue plasminogen activator [tPA], fibrinogen, PAI-l antigen, and PAI-l activity, in a group of diabetic patients offspring in comparison with healthy control subjects who have no family history of diabetes. We also investigated relationships between these parameters and plasma insulin levels. We studied 40 nondiabetic offspring of type 2 diabetic population. There were 25 normoglycemic subjects without a family history of diabetes who served as the control group. Fasting and post-load insulin concentrations were significantly higher in the offspring group compared with those in the control group. Plasma fibrinogen and LPA antigen concentrations were comparable between offspring and control subjects. Plasma PAI-l antigen concentration was higher in offspring compared with control subjects. Similarly, plasma PAI-l activity was significantly higher in offspring compared with control subjects. Plasma PAI-l activity was positively correlated with plasma PAI-l antigen and fibrinogen concentrations. PAI-l activity also had an inverse correlation with HDL cholesterol concentration, and was significantly correlated with the Waist Hip Ratio [WHR], plasma fibrinogen, plasma tPA antigen, and HDL cholesterol. These data suggest that none obese normal glucose tolerant offspring of type 2 diabetic subjects have elevated PAI-l activity indicating to hypofibrinolysis. Despite the presence of hyperinsulinemia and, possibly, insulin resistance, there is no association between insulin levels and PAI-l activity in these subjects. Hypofibrinolysis associated with enhanced PAI-l activity may be a risk factor for early development of atherosclerosis in these subjects who are genetically prone to the development of diabetes in the future. Large-scale controlled studies are required to elucidate whether the increased prevalence of cardiovascular diseases present even at the diagnosis of overt diabetes is related to hypofibrinolysis, in the prediabetic state

New risk factor; instability among osteoporotics

People affected by osteoporosis are at particular risk for bone fractures caused by falls. Preventive intervention depends on first describing the risk factors for falls present in this population as a group and as individuals. The aim of this study was to study the balance characteristics in persons with Osteoporosis and its relationship to the frequency of falls. Forty postmenopausal females with OP, diagnosed on the basis of bone mineral content, were included in this study. The ages were ranged from 51 to 78 Years. The patients were divided into two groups: -G1-OP with normal posture [n=25] and G2-OP with kyphosis [n=15]. Kyphosis was defined as a Cobb angle of more then 54°. The results of the study proved that: both groups with osteoporosis had different balance control strategies. Specifically, those with osteoporosis had greater postural sway than the other group. Patient with osteoporosis, particularly those with kyphosis have unique balance features with high SI that may destabilize them during ADL. The use of balance stabilometry to assess balance in person with osteoporosis promises to predict the frequency of falls. Balance rehabilitation may help to reduce falls. In the meantime, it seems logical to objectively asses the balance system of persons who are at risk for injurious falls as a means to provide the best rehabilitation programs available that may help to reduce falls

Outcome of transpedicular screw fixation in surgical treatment of isthmic spondylolisthesis in adults

Isthmic lumbar spondylolisthesis is a complex orthopedic and neurosurgical problem. Between 1995 and 2000, twenty three adult patients with symptomatic isthmic lumbar spondylolisthesis who failed to respond to conservative treatment were operated upon by posterolateral fusion and transpedicular screw fixation combined with a variety of decompressive procedures; namely, decompressive laminectomy, excision of fibrocartilaginous pseudoarthrotic mass and/or foraminotomy when indicated by preoperative imaging studies and operative findings. The surgical results were evaluated at an average follow up of 21 months. Nineteen patients had favorable clinical outcome. Solid fusion was evident in 20 patients. Individual clinical symptoms showed variable degrees of improvement. Low back pain improved at variable degrees in 91.3%, sciatica improved in 89%, intermittent claudications improved in 75% and neurological deficits improved in 87.5%. Loosening of screws was the commonest complication encountered occurring in 2 patients. In this study, posterolateral fusion combined with an appropriate decompressive procedure and instrumentation by transpedicular screws without reduction for isthmic spondylolisthesis in adults resulted in a high fusion rate and favorable clinical outcome